Neurological Symptoms and Organic Abnormalities

Sung Cho^*
*Correspondence: Sung Cho, Department of Neurology, Thomas Jefferson University, Philadelphia, USA, Email:

Introduction

Pediatric functional neurologic disorders are a group of conditions characterized by neurological symptoms that cannot be explained by structural or organic abnormalities. These disorders, also known as conversion disorders or functional neurological symptom disorders, primarily affect children and adolescents. FNDs manifest as functional deficits or abnormalities in motor, sensory, or cognitive domains, causing significant impairment in daily functioning. Understanding and effectively managing pediatric FNDs is crucial for providing appropriate care and improving the quality of life for affected children and their families. Pediatric FNDs are thought to arise from a complex interplay of genetic, psychological, and environmental factors. Emotional stress, trauma, and psychosocial factors often contribute to the onset and maintenance of symptoms. The underlying mechanism of pediatric FNDs involves altered central nervous system processing, leading to the generation of functional symptoms. Functional motor symptoms can manifest as weakness or paralysis, tremors, dystonia, gait disturbances, or movement disorders. These symptoms may resemble those seen in organic neurological conditions such as cerebral palsy or epilepsy but lack the corresponding neuroanatomical or neurophysiological basis. Medications, such as selective serotonin reuptake inhibitors may be prescribed in collaboration with a child psychiatrist or pediatrician. Close collaboration among healthcare providers involved in the management of pediatric FNDs is essential.

Description

Functional sensory symptoms involve abnormalities in sensory perception, such as altered sensations, numbness, tingling, or loss of sensation. These symptoms may mimic those observed in peripheral neuropathies or sensory deficits but are not explained by underlying structural or physiological abnormalities. Functional cognitive symptoms encompass a broad range of deficits, including memory impairment, attention difficulties, language disturbances, or confusion. These symptoms may overlap with those seen in organic neurological conditions such as epilepsy or traumatic brain injury but lack objective evidence of underlying pathology. Diagnosing pediatric FNDs can be challenging due to the absence of specific diagnostic tests or biomarkers. The diagnosis is primarily clinical and relies on a comprehensive assessment that includes medical history, physical examination, and careful evaluation of symptoms. Diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases provide guidance for identifying and classifying pediatric FNDs. The evaluation of pediatric FNDs involves a multidisciplinary approach, including input from pediatric neurologists, child and adolescent psychiatrists, and psychologists. The assessment aims to rule out organic or structural causes of symptoms through neuroimaging, laboratory tests, and specialized diagnostic procedures when necessary. CBT can be particularly effective in reducing symptom severity and improving overall functioning. Physical and occupational therapy play a vital role in the management of pediatric FNDs [1].

Psychological assessment tools, such as questionnaires and interviews, help assess the presence of psychosocial stressors, emotional distress, and maladaptive coping strategies. Collaboration with pediatric neuropsychologists can provide valuable insights into cognitive functioning and identify any underlying psychological factors contributing to symptomatology. The management of pediatric FNDs involves a multidisciplinary, biopsychosocial approach. The primary goals are to alleviate symptoms, improve daily functioning, and enhance the child's overall well-being. Providing accurate information to the child, parents, and caregivers about the nature of FNDs is essential. Psychoeducation helps normalize symptoms and reduces fear and uncertainty. This approach encourages active participation in treatment and promotes the development of coping mechanisms. Cognitive-behavioral therapy is a cornerstone in the management of pediatric FNDs. CBT focuses on identifying and modifying maladaptive thoughts, emotions, and behaviors associated with symptoms. It helps children develop healthier coping strategies, build resilience, and reduce symptom severity. Physical and occupational therapy play a crucial role in managing functional motor symptoms. These therapies aim to improve mobility, coordination, strength, and functional skills. Therapists employ techniques such as graded motor imagery, desensitization, and relaxation exercises to help restore normal motor function [2].

Involving the family in therapy sessions can aid in understanding and addressing familial dynamics, communication patterns, and potential stressors that may contribute to symptom presentation. Family therapy promotes supportive relationships, improves family functioning, and enhances the child's social support network. Pharmacological interventions in pediatric FNDs are generally limited and are primarily used to manage comorbid conditions such as anxiety or depression. Selective serotonin reuptake inhibitors or other appropriate medications may be prescribed under the guidance of a child psychiatrist or pediatric neurologist. Close collaboration between healthcare providers, including pediatric neurologists, psychiatrists, psychologists, therapists, and educators, is crucial for an integrated and holistic approach to management. Regular communication and coordination help ensure comprehensive care and continuity of treatment. Pediatric functional neurologic disorders present unique challenges for both patients and healthcare providers. Understanding the complex interplay between psychological, genetic, and environmental factors contributing to symptomatology is key. By employing a multidisciplinary approach encompassing psychological interventions, physical and occupational therapies, and family support, healthcare professionals can effectively manage pediatric FNDs, improve symptomatology, and enhance the quality of life for affected children and their families. These therapies aim to improve physical functioning, enhance mobility, and provide strategies for symptom management. Rehabilitation programs also promote activity normalization and functional recovery. In some cases, pharmacotherapy may be considered to address comorbid conditions, such as anxiety, depression, or sleep disturbances [3].

Pediatric functional neurologic disorders are a group of conditions characterized by abnormal neurological symptoms without an underlying organic or structural cause. These disorders, also known as conversion disorders or psychogenic disorders are prevalent in children and adolescents and can significantly impact their daily functioning and quality of life. Understanding the presentation, diagnosis, and management of pediatric FNDs is crucial for healthcare providers involved in the care of these young patients. Pediatric FNDs encompass a wide range of neurologic symptoms that can mimic organic neurologic conditions. The symptoms often appear suddenly and are inconsistent, varying in severity and location. Common symptoms include weakness or paralysis, abnormal movement sensory disturbances seizures or non-epileptic events, and gait abnormalities. Psychosocial stressors, such as family issues, school difficulties, or traumatic events, are frequently associated with the onset or exacerbation of symptoms. However, it is essential to note that the symptoms are not intentionally feigned or fabricated but rather represent a genuine expression of distress or psychological conflict. Diagnosing pediatric FNDs can be challenging due to the variability and overlap of symptoms with organic neurological conditions. A comprehensive approach is necessary, which includes thorough clinical evaluation, detailed medical history, physical examination, and appropriate investigations. CBT is an evidence-based psychotherapeutic approach that focuses on modifying maladaptive thoughts and behaviors. It helps identify and challenge negative beliefs related to symptoms, develop coping skills, and improve emotional regulation [4].

The diagnostic process often involves ruling out organic causes through neuroimaging, electroencephalography, electromyography and laboratory tests. These investigations help identify any underlying structural or metabolic abnormalities contributing to the symptoms. Once organic causes have been excluded, the diagnosis of a pediatric FND relies on the recognition of certain key features. These features include incongruity between clinical presentation and neuroanatomy, incongruity with recognized patterns of organic neurologic disease, and the presence of associated psychological stressors or conflicts. Additionally, the presence of clinical inconsistencies, such as distractibility or suggestibility, may support the diagnosis of a functional disorder. The management of pediatric FNDs requires a multidisciplinary approach, involving various healthcare professionals, including neurologists, psychiatrists, psychologists, and pediatricians. The primary goals of management are to alleviate symptoms, improve functioning, and address underlying psychosocial factors. Providing patients and families with accurate information about pediatric FNDs is crucial. Psychoeducation helps normalize the condition, reduces anxiety, and facilitates engagement in treatment. Supportive counseling, both individual and family-based, aims to address psychosocial stressors and provide coping strategies [5].

Conclusion

The prognosis for pediatric FNDs varies among individuals. Early recognition, appropriate intervention, and consistent engagement in therapy are associated with better outcomes. Many children experience significant symptom improvement or resolution over time. Long-term follow-up is crucial to monitor symptom stability and provide ongoing support. Regular assessments help identify any recurrence, new symptoms, or exacerbation of psychosocial stressors. Adjustments to treatment plans can be made based on the evolving needs of the child and family. Pediatric functional neurologic disorders present a unique challenge in the field of pediatric neurology. Recognizing the absence of organic causes and understanding the underlying psychosocial factors are key to accurate diagnosis and effective management. Through a multidisciplinary approach that integrates psychological interventions, physical and occupational therapy, and collaborative care, healthcare professionals can improve symptom management, enhance functioning, and support the overall well-being of children with pediatric FNDs. Regular communication and care coordination ensure a comprehensive approach and address both the physical and psychological aspects of the disorder. School personnel and other relevant stakeholders should also be involved to support the child's academic and social needs.

Acknowledgement

None

Conflict of Interest

None

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